CVS Health and Aetna shareholders signed off on the proposed $69 billion merger of the two healthcare companies, which is expected to close in the second half of this year. Now they await the federal government's approval.

The $67 billion merger would allow Cigna to lower its costs by insourcing PBM services, and absorb the profits of the biggest stand-alone PBM at a time when its competitors are also pairing up with providers of pharmacy services.

Ascension Health in Michigan is nearly complete with its employee layoffs and management restructuring as it has laid off 500 workers, including 20 executives or managers, at its 14 hospitals in Michigan.

As not-for-profit health systems merge and acquire new hospitals, they're increasingly faced with the difficult question of how to raise money. Some argue it's best done as a single parent foundation, while others say fundraising is best done at the local level.

Chicago-based revenue-cycle management company R1 RCM reported a net loss of $40.2 million in the fourth quarter of 2017 on $140.3 million in net services revenue compared with net income of $13.2 million on $106.2 in revenue million a year earlier.

Outside of small contracts, R1 RCM hasn't announced major revenue-cycle clients it didn't already have ties with since its 2011 partnership with Intermountain Healthcare. Investors will closely watch Friday's financial release for signs the company, formerly Accretive Health, is on the rebound.

The ratio of downgrades to upgrades among not-for-profit hospitals and health systems more than doubled in 2017 and was even higher than during the Great Recession in 2008 and 2009, according to a new report from Moody's Investors Service.